Alcohol Use and Preventing Alcohol-Related Problems Among Young
Adults in the Military

Genevieve Ames, Ph.D., and Carol Cunradi, M.P.H., Ph.D.

Genevieve Ames, Ph.D., is a senior research scientist, and Carol
Cunradi, M.P.H., Ph.D., is a research scientist, both at the Prevention Research
Center, Pacific Institute for Research and Evaluation, Berkeley, California.

Heavy alcohol use is a significant problem
in the military. Personnel often use alcohol in an attempt to cope with stress,
boredom, loneliness, and the lack of other recreational activities. The easy
availability of alcohol, ritualized drinking opportunities, and inconsistent
policies contribute to a work culture that facilitates heavy and binge drinking
in this population. Prevention strategies such as alcohol use policies combined
with campaigns focusing on alcohol deglamorization, personal responsibility,
and health promotion currently are being implemented to help reduce heavy
alcohol use, but further research is needed to evaluate the effects of these
efforts. Understanding the characteristics of military culture that encourage
or allow heavy and binge drinking practices also will help in designing effective
prevention approaches.

Relative to other substance use, heavy drinking (i.e., consuming
five or more drinks per typical drinking occasion at least once a week) appears
to be a particularly persistent problem in the military. Although illicit
drug use and cigarette smoking both decreased significantly over the period
from 1980 to 2002, heavy alcohol use did not show the same decline. In fact,
heavy alcohol use increased significantly from 1998 to 2002 for the first
time since 1988 (Bray et al. 2003). In 2002, 27 percent of young adults (i.e.,
18- to 25-year-olds) in the military reported heavy drinking, compared with
only 8.9 percent of 26- to 55-year-olds (Bray et al. 2003).

Heavy drinking also is prevalent among those entering the military.
A study tracking high school students into adulthood found that those who
entered the military were more likely than other young adults to have been
heavy drinkers in high school (Bachman et al. 1999).

When controlling for marital status, living arrangements, pregnancy,
and parenthood, military service itself seemed to contribute to the increases
in drinking. A study of young adults entering the U.S. Navy in 1998 examined
the degree to which their drinking patterns changed from pre-entry through
the first 3 years of service (Ames et al. 2004). Before entering the military,
approximately 26 percent of recruits (average age 19) reported frequent heavy
drinking (i.e., consuming at least five drinks [for men] and at least four
drinks [for women] per typical drinking occasion at least once a week throughout
the previous year) (Ames et al. 2002a). At followup 2 years later,
the overall prevalence of frequent heavy drinking (23 percent) within the
study’s cohort remained largely unchanged (Ames et al. 2004). The study
found that 2 years into their military enlistment, heavy drinkers could be
classified in near-equal numbers as (1) those who were pre-enlistment heavy
drinkers and continued the same drinking pattern, and (2) those who were not
pre-enlistment heavy drinkers but began heavy drinking after completing their
training (Ames et al. 2004). These findings suggest that young adults in the
military are at risk for alcohol-related problems, making them important candidates
for alcohol-related prevention programs.

This article reviews the prevalence of alcohol use among young adults
in all four branches of the military, comparing their drinking rates with
those of young adult civilians, whether or not they are enrolled full-time
in college. Risk factors for heavy drinking among young adults in the military
are discussed, along with strategies for reducing hazardous drinking among
these young people.

RATES OF ALCOHOL USE AMONG YOUNG MILITARY PERSONNEL

Rates of heavy alcohol use among 18- to 25-year-old military personnel
differ significantly by service branch and by gender, as shown in the accompanying
table. For example, young males in the Marines Corps have the highest rate
of heavy alcohol use, at 38.6 percent; among males in the Air Force, the rate
is 24.5 percent. Young men in the Army and Navy have similar rates of heavy
drinking (Army: 32.8 percent, Navy: 31.8 percent). A somewhat different pattern
of heavy drinking rates is observed for young women. Rates of heavy drinking
are higher for women in the Marine Corps (12.9 percent) and Navy (11.5 percent)
and lower in the Air Force and Army (6.3 percent in each). Rates of heavy
drinking in all service branches are nearly four times higher among young
men (32.2 percent) than among young women (8.1 percent). In addition, more
than half (53.8 percent) of all young military personnel reported at least
one episode of binge drinking (defined here as having consumed five or more
drinks on the same occasion at least once in the past 30 days) (Bray et al.
2003).

In terms of alcohol-related problems, Bray and colleagues (2003)
found that the highest levels of negative effects—serious consequences
(e.g., missing a week or more of duty because of a drinking-related illness
or being arrested for driving while impaired1), productivity loss,
and dependence symptoms—occurred among military personnel in the lowest
pay grades (i.e., E1 to E3). (1 Other serious consequences included
not being promoted, receiving a low performance rating, being arrested for
another alcohol-related reason, being involved in a traffic crash resulting
in injury or property damage, and fighting while drinking.) These pay grades
generally correspond to the youngest enlisted service members, who typically
lack a college education. During 2002, 20.2 percent of junior enlisted personnel
reported serious alcohol-related consequences, 27.2 percent reported lost
productivity, and 22.6 percent reported symptoms of dependence.

Military vs. Civilian Alcohol Use

The prevalence of heavy alcohol use among young military personnel
differs markedly from that of civilians in the same age group, as revealed
by standardized comparisons. Standardization is a set of techniques used to
remove, as far as possible, the effects of differences in age, gender, or
other confounding factors when comparing two populations (Last 1988). As the
table shows, young men in each service branch had significantly higher rates
of heavy drinking than their civilian counterparts. Of the young men in all
branches of the military, 32.2 percent engaged in heavy drinking, compared
with 17.8 percent of civilian men. Women serving in the Navy and the Marine
Corps had significantly higher rates (11.5 percent and 12.9 percent, respectively)
than civilian women (5.5 percent); rates among women in the Army and Air Force
(6.3 percent in each) did not differ significantly from those of their civilian
counterparts.

Standardized Comparisons of the Prevalence of Heavy Alcohol Usea
Among 18- to 25-Year-Old Military Personnel and Civilians, Past 30 Days,
by Gender, 2001–2002

Comparison
Population

Gender

Civilian

Total DOD

Army

Navy

Marine Corps

Air Force

Males

17.8% (0.5)

32.2% (2.3)b

32.8% (2.5)b

31.8% (3.5)b

38.6% (4.0)b

24.5% (3.2)b

Females

5.5% (0.3)

8.1% (1.0)b

6.3% (1.7)

11.5% (2.7)b

12.9% (2.3)b

6.3% (1.4)

In Total Population

15.3% (0.4)

27.3% (2.1)b

27.6% (2.4)b

26.0% (4.0)b

35.4% (4.8)b

19.8% (2.0)b

NOTE: Table entries are percentages, with standard errors in parentheses.
Civilian data have been standardized to the U.S.-based military data by
gender, age, education, race/ethnicity, and marital status. Data for the
total Department of Defense and the individual services are U.S.-based population
estimates (including personnel in Alaska and Hawaii). Estimates have not
been adjusted for sociodemographic differences among services.

a Defined as consumption of five or more drinks on the same
occasion at least once a week in the past 30 days.

b Significantly different from the civilian estimate at the
95-percent confidence interval.

SOURCE: Prevalence estimates for civilians were taken from the 2001 National
Household Survey on Drug Abuse (Substance Abuse and Mental Health Services
Administration 2002). Data for military personnel were obtained from the
2002 Department of Defense Survey of Health Related Behaviors Among Military
Personnel (Bray et al. 2003).

The figure accompanying this article highlights military–civilian
differences in two types of hazardous drinking among young adults: heavy
drinking and binge drinking. This figure compares rates of hazardous drinking
for young adults (18–25 years old) in the military, civilian young
adults (18–22 years old) enrolled full-time in college, and civilian
young adults not enrolled full-time in college. The military data are from
Bray and colleagues (2003), and the civilian data were obtained from the
2001 National Household Survey on Drug Abuse (Substance Abuse and Mental
Health Services Administration [SAMHSA] 2002). Rates of both heavy drinking
and binge drinking are higher among young adults in the military than young
adult civilians, regardless of their college enrollment status. It should
be noted that heavy drinking was defined slightly differently in the military
and civilian surveys, and the civilian age group (18–22) was smaller
than the military age group (18–25). These differences may explain
some of the variability found in the rates that were compared.

Hazardous drinking among young adults in the military and civilians,
by college enrollment status, 2002.

RISK FACTORS FOR HEAVY DRINKING AMONG YOUNG MILITARY ADULTS

The likelihood of heavy drinking was significantly higher after adjusting
for six sociodemographic variables (Bray et al. 2003): branch of service (Army
and Marine Corps personnel compared with Air Force personnel); gender; race/ethnicity
(non-Hispanic Whites compared with non-Hispanic African Americans and those
in the “other” racial/ethnic category2); education
(those with a high school education or less compared with college graduates);
age (those ages 21 to 25 compared with those age 35 or older); and marital
status (those who were single or married with their spouse absent compared
with those who were married with their spouse present). (2 The
“other” category includes all people not classified elsewhere,
such as Native Americans or Asians.) In addition to these sociodemographic
risk factors for heavy drinking among military personnel, the military’s
workplace culture and alcohol availability also may influence drinking practices
in this population.

Workplace Culture

Research has shown that groups of people who work together, whether in small
teams or larger organizations, develop shared beliefs and practices that can
influence alcohol use (see Trice and Sonnenstuhl 1990; Ames and Janes 1992).
Workplace culture in the military, just as in other occupations, can be a
risk factor for heavy alcohol use. For example, the workplace culture can
influence beliefs about acceptable drinking contexts (most notably, drinking
rituals with coworkers before, during, or after work); as well as drinking
behavior (e.g., number of drinks, openly showing the effects of alcohol, getting
into fights, arguing with supervisors, sleeping on the job, coming to work
with a hangover) (Ames et al. 1997); and expectations about the positive or
negative consequences of drinking (Grube et al. 1994).

Ames and colleagues (2004) recently studied the influence of workplace culture
on drinking practices in various military settings of the Navy. Face-to-face
interviews with young Navy personnel revealed established drinking rituals
and routines as well as elements of the work environment that encouraged drinking
at work on land bases and during deployment liberties (i.e., shore leave).
For example, young sailors viewed drinking with coworkers during the work
week as an appropriate coping mechanism in response to stress, boredom, loneliness,
and lack of other recreational activities. The respondents described heavy
(i.e., five drinks or more for men and four drinks or more for women per typical
drinking occasion) and binge drinking behavior after work, and especially
drinking on liberty during deployment, as part of a cultural tradition. (Binge
drinking was defined in this study as five drinks or more for men and four
drinks or more for women within a 2-hour period.) On deployment liberty, binge
drinking and drinking to the point of intoxication were not necessarily viewed
as inappropriate or punishable behavior, unless sailors were too intoxicated
to return to ship at the designated time. The researchers found that cultural
norms for drinking during shore leave3 were significantly associated
with frequent heavy drinking, the number of days on which binge drinking occurred,
and the average amount of alcohol consumed daily (Ames et al. 2004). (3
Cultural norms were based on the respondent’s perceptions about
whether his or her supervisor, friends, or coworkers would disapprove or approve
of drinking during shore leave and how many drinks the respondent thought
his or her supervisor, friends, or coworkers usually had when they drank.)

Alcohol Availability

Another factor that may influence heavy and binge drinking among young adults
in the military is the physical and social availability of alcohol. Alcohol
availability is a known risk factor for increased alcohol use in the general
population (Gruenewald et al. 1993) and in occupational settings (Ames and
Grube 1999). For example, the personnel interviewed in the Navy study reported
that alcohol and opportunities for drinking were easily available both in
foreign ports (where the U.S. minimum legal drinking age usually does not
apply) and on U.S. bases. On base, beer and spirits are stacked for display
at the entry to the post exchange. Navy underage recruits reported that they
had easy access to alcohol in bars, in the barracks, or in hotel rooms near
the base. On shore leave in foreign ports, alcohol was reportedly inexpensive,
bars were located near the point of disembarkation, few ports had underage
drinking laws, and most sailors who wanted to drink organized drinking groups
before disembarking (Ames et al. 2004).

STRATEGIES TO PREVENT ALCOHOL PROBLEMS

As demonstrated in the Navy study, factors contributing to alcohol use among
young adults in the military may include established drinking cultures that
feature drinking rituals and traditional celebrations, expectations about
heavy drinking after work and while on leave, drinking to cope and as a recreational
activity, and the social and physical availability of alcohol. Strategies
to prevent alcohol misuse and related problems in this population, therefore,
may attempt to target these factors.

Current strategies to prevent alcohol problems among military personnel
include instituting and enforcing policies that regulate alcohol availability
and pricing, deglamorizing alcohol use, and promoting personal responsibility
and good health.

Although the U.S. military has implemented policies and programs designed
to reduce alcohol use and related problems among personnel, examples of which
are described below, there has been little formal evaluation of these programs.
This is an important area for future research, as evaluation is a critical
component of any comprehensive prevention program. Thus, despite the military’s
efforts to address problem drinking, the effectiveness of these programs in
reducing or preventing hazardous drinking and its attendant problems remains
largely unknown. The programs described below are representative of the military’s
prevention efforts; future research will be needed to evaluate their utility.

Alcohol Use Policies

For many work organizations, an important strategy for minimizing alcohol
problems among employees is the establishment and enforcement of workplace
alcohol use policies. Such policies can help to change the characteristics
of the workplace culture or other social environments that support heavy and
binge drinking. The U.S. military adopted strict policies in the early 1980s
with the aim of reducing rates of alcohol, tobacco, and illicit drug use (Department
of Defense [DOD] 1980). These policies included components for detection,
treatment and rehabilitation, and prevention. An analysis of survey data from
1980 to 1995 found lower rates of illicit drug use among military personnel
relative to civilians, suggesting that the policies were effective in this
regard (Bray and Marsden 2000). However, such differences were not found in
the rates of alcohol use, especially when accounting for demographic changes
in the military, suggesting that the substance use policies have not been
effective in reducing alcohol use (Bray and Marsden 2000).

In another study, Bachman and colleagues (1999) compared changes in substance
use rates among young military recruits before and 2 years after enlistment
with changes in use rates among their civilian counterparts. Examining trends
in these comparisons across two decades, the researchers found that rates
of illicit drug use decreased more among the military recruits than among
civilians, especially after the military implemented mandatory routine drug
testing in 1980. Although the rates of heavy drinking also decreased over
the past two decades for both military recruits and civilians, the researchers
did not find sufficient differences in the rates to indicate that military
alcohol policies have been particularly effective (Bachman et al. 1999).

In contrast, Voas and colleagues (2002) reported findings on the positive
effects of a specific policy change designed to reduce off-base alcohol use
among young marines stationed near the Mexican border. Marines stationed at
Camp Pendleton, California, 67 miles from the Mexican border, were drawn to
the bars in Mexico by inexpensive alcohol and a minimum drinking age of 18,
and often returned to base on weekend nights with high blood alcohol contents
(BACs). In response, commanders at Camp Pendleton adopted a policy that required
marines to receive written permission to cross the border. After the policy
was implemented, the number of underage marines returning across the Mexican
border was reduced by 78 percent, and the number returning with BACs of 0.08
percent or higher was reduced by 84 percent. The authors note that several
elements of the policy change may have contributed to the outcome. For example,
marines applying for permission to cross the border received information warning
of the possible problems involved, including the potential for disciplinary
action. The fact that the new policy required more effort and planning by
the young marines also may have served as a deterrent (Voas et al. 2002).

Alcohol Pricing

Research suggests that alcohol use and related problems are reduced when
alcoholic beverage prices are increased (Cook and Moore 2002). DOD policies,
however, allow alcoholic beverages sold in military stores to be discounted
below prices in local civilian stores. The DOD’s Alcohol Abuse Prevention
Strategic Plan states that alcoholic beverages in military stores should be
priced at no more than 5 percent below the local competitive price, except
in States with alcohol beverage control boards, where prices should be no
more than 10 percent below the local competitive price (DOD 1999). A 1997
review by the Office of the Inspector General found that these policies were
used to set store prices and that patrons of military retail stores benefited
from additional discounts because of the stores’ exemption from sales
tax. The review reported, for example, that the prices on beverages sold at
a military retail store in one area ranged from 9 percent to 27 percent less
than prices in State-operated alcohol stores. The authors concluded that the
DOD’s pricing policy was inconsistent with its policy for maintaining
a healthy active-duty force, and they recommended that prices in military
stores equal those charged in the commercial retail market (Office of the
Inspector General 1997).

Alcohol Use Deglamorization

All branches of the U.S. military have made efforts to deglamorize the use
of alcohol, providing nonalcoholic beverages at functions where alcohol is
served and emphasizing that alcohol use before or during work hours is unacceptable.
The Navy’s “Right Spirit” campaign calls for removing alcohol
from tradi­tional ceremonies, providing alternatives to drinking, recognizing
the effects of alcohol use, and promoting personal responsibility concerning
alcohol use (Bickford et al. 2004). The Navy Alcohol and Drug Abuse Prevention
Program credits this campaign for a nearly 40-percent reduction in alcohol-related
incidents (i.e., infractions in which alcohol played a role) from 1996 to
2000, and for a nearly 50-percent decline in arrests for driving under the
influence (U.S. Navy 2005).

A survey of Air Force officers attending Air Command and Staff College (ACSC)
sought to determine the degree to which the Air Force deglamorization campaign
is reflected in the alcohol use norms of ACSC students. Survey respondents
generally agreed that the ACSC environment is supportive of alcohol deglamorization
but noted that despite the deglamorization efforts, students’ attention
often is focused on alcohol, bringing alcohol to social activities is emphasized,
and the student population does not consistently view drinking during the
workday as unacceptable (Lyman 1999). The author recommended that the ACSC
command structure and faculty support the deglamorization campaign by continuing
to emphasize responsible alcohol use, encouraging the use of designated drivers,
and recommending alcoholism treatment when necessary.

Personal Responsibility Campaigns

Alcohol policies in the military often emphasize each individual’s
personal responsibility regarding alcohol use. For example, alcohol policies
in the Navy emphasize “responsible use” or “the application
of self-imposed limitations of time, place, and quantity when consuming alcoholic
beverages” (Bickford et al. 2004). The Navy’s “Best Practices”
program aims to reduce alcohol and other drug problems among young at-risk
personnel by stressing relationships, relevance, and responsibility. The program
emphasizes the impact of each person’s behavior on the organization.
It encourages those in command to foster positive professional relationships
with sailors and focuses on the responsibility of leaders to ensure that sailors
live and work in an environment conducive to learning. The program also focuses
on the responsibility of sailors to learn and understand Navy policies and
expectations. Other elements of the program include providing alternative
activities to engage sailors during free time, education sessions including
drug abuse awareness training, and consistent use of discipline in response
to violations (see the Web site of the Navy Alcohol and Drug Abuse Prevention
Program at http://www.npc.navy.mil/CommandSupport/NADAP/).

Another Navy program, PREVENT (Personal Responsibility: Values and Education
Training) aims to provide 18- to 26-year-old sailors with the education and
skills necessary to encourage them to act as personally responsible, contributing
members of the Navy. Evaluations are not formalized, but the findings reported
by the Navy indicate that sailors who attended PREVENT sessions had fewer
binge drinking episodes compared with their pre-enlistment frequencies and
showed a greater personal awareness and responsibility for their alcohol use
patterns and consequences (U.S. Navy 2004).

Health Promotion Programs

In 1986, the U.S. military adopted a comprehensive policy to foster general
health promotion among military personnel, including strategies to reduce
substance abuse within this directive. In addition to alcohol and other drug
abuse prevention, the policy included measures for smoking prevention and
cessation, physical fitness, nutrition, stress management, and the prevention
of hypertension (DOD 1986). A 1991 survey of Army personnel found that those
who reported hazardous drinking (defined as 21 or more drinks per week for
men, 14 or more for women) were more likely than other drinkers to engage
in risky behaviors such as speeding, tobacco use, and not wearing seat belts.
Hazardous drinkers tended to be younger and were less likely to be married.
The authors suggest that, given the association between hazardous drinking
and other risky behaviors, incorporating alcohol abuse prevention into general
health promotion programs may be an especially effective strategy for this
population (Fertig and Allen 1996).

SUMMARY

As surveys of military personnel indicate, heavy alcohol use remains a problem
in this population. Those especially likely to report heavy drinking are young
non-Hispanic White men, with a high school education or less, who are either
single or married but living away from their spouse. Military personnel report
that drinking often is used to cope with stress, boredom, loneliness, and
the lack of other recreational activities. The easy availability of alcohol
and drinking opportunities also contributes to alcohol use in this population.

Military alcohol use policies combined with campaigns focusing on alcohol
deglamorization, personal responsibility, and health promotion may help reduce
heavy alcohol use in this population, but further research is needed to evaluate
the effects of these measures. The recent increase in heavy drinking seen
throughout the military suggests that these efforts have not been successful
in countering hazardous drinking behavior. Most importantly, more research
is needed to gain greater understanding of the characteristics of the military
culture that promote or allow heavy drinking and binge drinking practices.
Based on findings from solid empirical research, the next step would be to
develop systemwide approaches to modifying the aspects of the military environment
that show the most promise for lowering alcohol consumption rates among young
adults, thereby reducing the prevalence of heavy and binge drinking and related
problems to a level far below those reported in this paper.

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Heavy Drinking Among Military Workers.” Paper presented at the Research
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Ames, G.M.; Baraban, E.A.; Cunradi, C.B.; and Moore, R.S. “A Longitudinal
Study of Drinking Behavior Among Young Adults in the Military.” Paper
presented at the Research Society on Alcoholism Annual Scientific Meeting,
Vancouver, BC, June 2004.

Bachman, J.G.; Freedman-Doan, P.; O’Malley, P.M.; et al. Changing
patterns of drug use among U.S. military recruits before and after enlistment.
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Bickford, A.J.; Ames, G.M.; and Moore, R.S. “Alcohol Policy in the
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Bray, R.M., and Marsden, M.E. Trends in substance use among U.S. military
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